Cara L. McDermott

Completion of Radiotherapy for Local and Regional Head and Neck Cancer in Medicare

OBJECTIVE To identify factors associated with interruption or early discontinuation of treatment in patients receiving radiotherapy for head and neck cancer, because it is believed that such treatment interruption or early discontinuation increases the risk of disease relapse and adversely influences survival. DESIGN, SETTING, AND PATIENTS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified Medicare beneficiaries 66 years or older who were diagnosed as having local or regional head and neck cancer from January 1, 1997, through December 31, 2003. For each case, we calculated the timing and duration of radiotherapy using Medicare claims data. We then performed logistic regression analyses to estimate the association between tumor and clinical characteristics and early discontinuation of and/or interruptions in radiotherapy. MAIN OUTCOME MEASURE Completion of uninterrupted radiotherapy. RESULTS A substantial proportion of patients (39.8% overall) had interruptions in radiotherapy and/or incomplete therapy. Altogether, 70.4% of surgical patients completed radiotherapy with no interruptions compared with 52.0% of nonsurgical patients (chi(2) = 78.17; P < .001). Surgery was associated with an increased likelihood of completing uninterrupted radiotherapy for all tumor sites. Comorbidity, chemotherapy, and regional disease were all associated with a decreased likelihood of completing radiotherapy at a subset of sites. CONCLUSIONS Failure to complete uninterrupted radiotherapy is common among Medicare enrollees with head and neck cancer. Surgery before radiotherapy is associated with an increased likelihood of completing radiotherapy. At a subset of sites, chemotherapy is associated with a decreased likelihood of completing radiotherapy. Further research is needed to identify factors associated with noncompletion of radiotherapy among nonsurgical patients and patients who receive chemotherapy.

Will knowledge of gene-based colorectal cancer disease risk influence quality of life and screening behavior? Findings from a population-based study.

Background: Several gene variants conveying a modestly increased risk for disease have been described for colorectal cancer. Patient acceptance of gene variant testing in clinical practice is not known. We evaluated the potential impact of hypothetical colorectal-cancer-associated gene variant testing on quality of life, health habits and cancer screening behavior. Methods: First-degree relatives of colorectal cancer patients and controls from the Seattle Colorectal Cancer Familial Registry were invited to participate in a web-based survey regarding testing for gene variants associated with colorectal cancer risk. Results: 310 relatives and 170 controls completed the questionnaire. Quality of life for the hypothetical carrier state was modestly and nonsignificantly lower than current health after adjustment for sociodemographic and health factors. In the positive test scenario, 30% of respondents expressed willingness to change their diet, 25% to increase exercise, and 43% to start colorectal cancer screening. The proportions willing to modify these habits did not differ between groups. Conclusions: Testing for gene variants associated with colorectal cancer risk may not influence quality of life, but may impact health habits and screening adherence. Changing behaviors as a result of testing may help to reduce cancer incidence and mortality, particularly among those at higher risk for colorectal cancer.

Colony-Stimulating Factor Use and Impact on Febrile Neutropenia Among Patients with Newly Diagnosed Breast, Colorectal, or Non–Small Cell Lung Cancer Who Were Receiving Chemotherapy

To determine the impact of primary prophylactic colony‐stimulating factor (CSF) use on febrile neutropenia in a large patient population receiving contemporary chemotherapy regimens to treat breast cancer, colorectal cancer, or non–small cell lung cancer (NSCLC).

Patterns of blood product use among patients with myelodysplastic syndrome

Background and Objectives  Most patients with myelodysplastic syndrome (MDS) require blood product support to manage the severe anaemias, which frequently accompany MDS. Our objective was to show the feasibility of linking the Surveillance, Epidemiology and End Results (SEER) database with records from Puget Sound Blood Center (PSBC) to characterize blood product use over time in successive cohorts of patients with MDS.

A comparison of approaches for association studies of polymorphisms and colorectal cancer risk

Aim  Meta‐analyses have been used to evaluate associations between polymorphisms and colorectal cancer risk, but the quality of individual studies used to inform them may vary substantially. Our aim was to apply well‐established quality‐control criteria to individual association studies and then compare the results of meta‐analyses that included or excluded studies that did not meet these criteria.

End-of-Life Services Among Patients With Cancer: Evidence From Cancer Registry Records Linked With Commercial Health Insurance Claims

PURPOSE Despite guidelines emphasizing symptom management over aggressive treatment, end-of-life care for persons with cancer in the United States is highly variable. In consultation with a regional collaboration of patients, providers, and payers, we investigated indicators of high-quality end-of-life care to describe patterns of care, identify areas for improvement, and inform future interventions to enhance end-of-life care for patients with cancer. METHODS We linked insurance claims to clinical information from the western Washington SEER database. We included persons ≥ 18 years of age who had been diagnosed with an invasive solid tumor between January 1, 2007, and December 31, 2015, and who had a recorded death date, were enrolled in a commercial plan for the last month of life, and made at least one insurance claim in the last 90 days of life. RESULTS In the last month of life, among 6,568 commercially insured patients, 56.3% were hospitalized and 48.6% underwent at least one imaging scan. Among patients younger than 65 years of age, 31.4% were enrolled in hospice; of those younger than 65 years of age who were not enrolled in hospice, 40.5% had received an opioid prescription. Over time, opioid use in the last 30 days of life among young adults not enrolled in hospice dropped from 44.7% in the period 2007 to 2009 to 42.5% in the period 2010 to 2012 and to 36.7% in the period 2013 to 2015. CONCLUSION Hospitalization and high-cost imaging scans are burdensome to patients and caregivers at the end of life. Our findings suggest that policies that facilitate appropriate imaging, opioid, and hospice use and that encourage supportive care may improve end-of-life care and quality of life.

Using cancer registry records linked with health insurance records to measure costs and services at end-of-life.

186 Background: Studies suggest that end-of-life (EOL) care for persons with cancer in the United States is variable and often misaligned with patient and family preferences. To better understand these issues, we developed reports on high-priority quality indicators and costs at EOL. METHODS Surveillance, Epidemiology, and End Results (SEER) records for solid tumor patients diagnosed with cancer in Western Washington state between 1/1/2007 and 12/31/2015 were linked with enrollment and claims from two regional commercial insurers. Using claims, we then developed algorithms to characterize EOL care for breast, colorectal, and non-small cell lung cancer (NSCLC), including costs of care at 90- and 30-days prior to death. Costs include all claims paid for ED, hospital, outpatient, and pharmacy care. We estimated patient out-of-pocket costs as the difference between allowed and paid claim amounts. RESULTS See Table. Across the largest 10 clinics in the region there was considerable variability in the average costs of cancer care in the last 90 days of life. The clinic-specific average ranged from

Health care utilization and costs at end of life among patients with leukemia or lymphoma in a regional cancer registry-insurance claims linked database.

24,532 to

Colony-stimulating factor prescribing patterns in patients receiving chemotherapy for cancer.

72,931 for breast cancer,

Sensitivity of administrative claims to identify incident cases of lung cancer: a comparison of 3 health plans.

30,495 to